Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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It is Road's not drivers.
- Jeremy S Cox (11 April 2004)
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Re: It is Road's not drivers.
- David Carvel (12 April 2004)
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Advocacy should be based on Evaluation
- Dr Dorothy L Robinson (14 April 2004)
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The aquisition of accurate crash data
- J Mark AITKEN (19 April 2004)
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Jeremy S Cox, Locum GP BH20 6EW
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The cause of many accidents is not the driver or his alcohol content but the road layout or surface. Why do we put up signs for "Accident blackspots" instead of correcting the road layout that is the major cause of accidents at these locations? Competing interests: None declared |
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David Carvel, GP Biggar ML12 6BE, UK
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True Jeremy, but conversely the cause of many accidents IS the "driver or his alcohol content". Competing interests: None declared |
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Dr Dorothy L Robinson, Snr Statistician Univerisity of New England, Armidale, NSW 2351, Australia
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I was surprised by the claim that seatbelts prevent around 2,500 deaths and 25,000 serious injuries annually, with 'vociferous minorities' blamed for delaying or overturning major injury prevention policies.[1] Many people thought that the UK seatbelt legislation, introduced in January 1983, made sense. The DoT originally estimated it saved 207-459 lives per year. Unfortunately, reductions for front seat occupants were offset by increases for rear seat passengers, cyclists and pedestrians.[2] Until recently, I was unaware of subsequent analyses showing fatal crashes from 4 am to 10 pm fell by only 3% (in line with the prevailing trend), compared to 23% for crashes from 10 pm to 4 am (the "drink-drive hours").[3] The reduction was almost exclusively for drivers who had drunk alcohol crashing in non-built-up areas, with virtually no change for other categories (drivers who had not been drinking and crashes in built-up areas). In 1983, unprecedented numbers of breath tests were administered, successful prosecutions for drunk driving increased by 31% and the percentage of dead drivers over the legal alcohol limit dropped from 36% to 31%.[3] We cannot ignore such data. The only possible conclusion is that what was considered an effect of seatbelt legislation, was mainly due to a campaign against drink-driving. Perhaps if we had listened to the people presenting factual evidence from injury statistics before and after legislation, many more lives might have been saved by tackling the more important problem (drink-driving), instead of arguing about seatbelts and risk compensation.
True road safety advocacy requires a fourth 'E' - Evaluation. Outcomes such as risk compensation are often difficult to predict, so we need to compare injury statistics before and after all major interventions. Some have worked well; e.g. a campaign against speeding and drink-driving in Victoria, Australia, reduced pedestrian fatalities by 42% from 159 in 1989 to 92 in 1990. Others, such as seatbelt and bicycle helmet laws have not lived up to expectations. Advocates should campaign for full before-and-after evaluation of all major initiatives, so that the money and effort saves as many lives and prevents as many injuries as possible. References
Competing interests: None declared |
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J Mark AITKEN, Consultant Physician / Deputy Medical Director Colchester General Hospital, Turner Road, Colchester, Essex CO4 5JL
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EDITOR - One should not underestimate the barriers, highlighted by Jeanne Breen, that exist between establishing a risk for serious or fatal road casualties and the willingness of those in authority to assist the investigation or ultimately implement change [1]. Furthermore, acquiring good data on which to establish risk is hampered by a system which is biased in favour of the survivors of crashes, a Police force which has little commitment to establishing the facts or releasing the results of their investigations to the relatives of the deceased, and a Coroner's Court which lacks the determination or authority to question the validity of the Police accident report. Few readers of the BMJ will have been touched by the impact of a fatal road crash and will, therefore, be unaware of the haphazard way in which data is collected and the poor application of scientific principles to this area of investigation. Undue credibility is given to the statements of survivors who know that silent (dead) witnesses cannot testify. Whilst one would not want to say, in the case of fatal road crashes, that the survivors are guilty until proved innocent, rather that the survivors should establish their lack of culpability. This sounds like a semantic quibble, but until we apply the technology for acquiring crash data from the vehicles involved, rather than from their drivers, we will continue to accept circumstantial and heavily biased statements that exonerate those who may have perpetuated these violent acts. In view of the fact that we can produce cheap mobile phones capable of taking and transmitting instant images, surely it is not beyond our technological expertise to introduce a black box to monitor our vehicle's performance and ultimately provide that evidence to support or refute our culpability in the event of a crash? 1. Breen J. Road safety advocacy. BMJ 2004;328:888-90 Competing interests: None declared |
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Bicycle helmet legislation reveals a similar problem. Irrespective of whether helmets are effective, pre- and post-law comparisons show that legislation is counter-productive. In New Zealand (NZ), for example,
adult helmet wearing (%HW) increased dramatically (43% to 92%) with legislation, but not primary schoolchildren - most were already wearing helmets.
If legislation were effective, percent head injury (%HI) for adults should fall, because of the large increase in %HW, with little change in %HI of
primary schoolchildren.[4] The reality in NZ (see graph), and all other time series analysis comparing %HI of cyclists and other road users[2], is that increased %HW
from legislation has little or no effect on %HI. The most optimistic estimate is that the adult helmet law in NZ cost NZ$1.2 million per year, but saved at most NZ$0.03 million in healthcare costs.[5]